Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial.

Importance: Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. Objective: To compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography-confirmed uncomplicated acute appendicitis. Design, Setting, and Participants: The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. A total of 599 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were enrolled in the trial. The last date of follow-up was November 29, 2019. Interventions: Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days. Main Outcomes and Measures: The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference. Results: Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up. The treatment success rate at 1 year was 70.2% (1-sided 95% CI, 65.8% to ∞) for patients treated with oral antibiotics and 73.8% (1-sided 95% CI, 69.5% to ∞) for patients treated with intravenous followed by oral antibiotics. The difference was -3.6% ([1-sided 95% CI, -9.7% to ∞]; P = .26 for noninferiority), with the confidence limit exceeding the noninferiority margin. Conclusion and Relevance: Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups, but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics. Trial Registration: ClinicalTrials.gov Identifier: NCT03236961; EudraCT Identifier: 2015-003633-10.

Effect of tungsten and selenium on C1 gas bioconversion by an enriched anaerobic sludge and microbial community analysis.

The effect of trace metals, namely tungsten and selenium, on the production of acids and alcohols through gas fermentation by a CO-enriched anaerobic sludge in a continuous gas-fed bioreactor was investigated. The CO-enriched sludge was first supplied with a tungsten-deficient medium (containing selenium) and in a next assay, a selenium-deficient medium (containing tungsten) was fed to the bioreactor, at a CO gas flow rate of 10 mL/min. In the absence of tungsten (tungstate), an initial pH of 6.2 followed by a pH decrease to 4.9 yielded 7.34 g/L acetic acid as the major acid during the high pH period. Subsequently, bioconversion of the acids at a lower pH of 4.9 yielded only 1.85 g/L ethanol and 1.2 g/L butanol in the absence of tungsten (tungstate). A similar follow up assay in the same bioreactor with two consecutive periods at different pH values (i.e., 6.2 and 4.9) with a selenium deficient medium yielded 6.6 g/L acetic acid at pH 6.2 and 4 g/L ethanol as well as 1.88 g/L butanol at pH 4.9. The results from the microbial community analysis showed that the only known CO fixing microorganism able to produce alcohols detected in the bioreactor was Clostridium autoethanogenum, both in the tungsten and the selenium deprived media, although that species has so far not been reported to be able to produce butanol. No other solventogenic acetogen was detected.

Microalgae grow on source separated human urine in Nordic climate: Outdoor pilot-scale cultivation.

Human urine contributes approximately 80% of nitrogen and 50% of phosphorous in urban wastewaters while having a volume of only 1-1.5 L/d per capita compared to 150-200 L/d per capita of wastewater generated. There is interest to study source separation of urine and search methods to recover the nutrients form the urine. In this study, the objective was to use the nutrients in source separated urine for outdoor cultivation of microalgae in Nordic climate. A freshwater green microalga Scenedesmus acuminatus was grown in different dilutions (1:20 and 1:15) of source separated human urine, in a semi-continuously operated outdoor raceway pond with a liquid volume of 2000 L, at hydraulic retention time of 15 d. The microalgae could remove 52% nitrogen and 38% phosphorus even at culture temperatures as low as 5 °C, while obtaining a biomass density of 0.34 g VSS/L. Harvested microalgal biomass could be used to produce methane with a yield of 285 L CH4/kg volatile solids.

Effect of macro- and micro-nutrients addition during anaerobic mono-digestion of grass silage in leach-bed reactors.

The effect of macro- (NH4Cl) (set I) and micro-nutrients (Fe, Ni, Co and Mo) (set II) addition on chemical oxygen demand (COD) solubilisation during anaerobic mono-digestion of grass silage was investigated in two sets of leach bed reactor experiments at 35°C. Results showed that addition of NH4Cl and micro-nutrients improved COD solubilisation by 18% (0.56 g SCOD g-1 volatile solids) and 7% (0.45 g SCOD g-1 VS), respectively than control. About 20-50% of the added micro-nutrients were bioavailable in the produced leachates, while the rest (50-80%) were adsorbed onto the grass silage. Results of biological methane potential assays showed that, specific methane yields of grass silage were improved by 17% (0.36 ± 0.02 m3 CH4 kg-1 VSadded) when NH4Cl was supplemented while Fe, Ni, Co and Mo addition improved methane yields by 15% (0.33 ± 0.005 m3 CH4 kg-1 VSadded) when compared to control.

Influence of temperature and pretreatments on the anaerobic digestion of wastewater grown microalgae in a laboratory-scale accumulating-volume reactor.

This laboratory-scale study investigated the performance of a low-cost anaerobic digester for microalgae. Low (∼2%) solids content wastewater-grown microalgal biomass (MB) was digested in an unmixed, accumulating-volume reactor (AVR) with solid and liquid separation that enabled a long solids retention time. AVRs (2 or 20 L) were operated at 20 °C, 37 °C or ambient temperature (8-21 °C), and the influence of two pretreatments - low-temperature thermal (50-57 °C) and freeze-thaw - on algal digestion were studied. The highest methane yield from untreated MB was in the 37 °C AVR with 225 L CH4 kg volatile solids (VS)(-1), compared with 180 L CH4 kg VS(-1)added in a conventional, 37 °C completely stirred tank reactor (CSTR), and 101 L CH4 kg VS(-1)added in the 20 °C AVR. Freeze-thaw and low-temperature thermal pretreatments promoted protein hydrolysis and increased methane yields by 32-50% at 20 °C, compared with untreated MB. Pretreatments also increased the mineralisation of nitrogen (41-57%) and phosphorus (76-84%) during digestion. MB digestion at ambient temperature was comparable with digestion at 20 °C, until temperature dropped below 16 °C.

Agricultural potential of anaerobically digested industrial orange waste with and without aerobic post-treatment.

The potential of anaerobically digested orange waste with (AAD) and without (AD) aerobic post-treatment for use in agriculture was evaluated through chemical analyses, short-term phytotoxicity and long-term plant assays. Chemical analyses showed that AD contained ammonia and organic acids, and aerobic post-treatment did not significantly remove these phytotoxins. The N:P2O5:K2O ratio in AD was 1:0.26:0.96 and aerobic post-treatment did not change the composition in AAD except for K2O (1:0.26:1.24). Heavy metal contents in AD and AAD were more or less the same and were below the upper limit recommended for non-sewage sludge application on agricultural soils. Short-term phytotoxicity tests showed that seed germination and root elongation of Chinese cabbage and ryegrass were severely inhibited at digestate concentrations of 60-100%. Germination index values were well below the score of 50% required to indicate the phytotoxic-free nature of compost. Long-term plant assays showed that AD and AAD, when supplemented with a base fertilizer, resulted in higher plant growth, and fresh weight and dry matter production than AD without base fertilizer. The results thus indicate that aerobic post-treatment did not have any significant beneficial effect on reducing phytotoxicity, and AD could be used as such on agricultural soils, especially with high P.

Effects of heat treatment on hydrogen production potential and microbial community of thermophilic compost enrichment cultures.

Cellulosic plant and waste materials are potential resources for fermentative hydrogen production. In this study, hydrogen producing, cellulolytic cultures were enriched from compost material at 52, 60 and 70°C. Highest cellulose degradation and highest H(2) yield were 57% and 1.4 mol-H(2) mol-hexose(-1) (2.4 mol-H(2) mol-hexose-degraded(-1)), respectively, obtained at 52°C with the heat-treated (80°C for 20 min) enrichment culture. Heat-treatments as well as the sequential enrichments decreased the diversity of microbial communities. The enrichments contained mainly bacteria from families Thermoanaerobacteriaceae and Clostridiaceae, from which a bacterium closely related to Thermoanaerobium thermosaccharolyticum was mainly responsible for hydrogen production and bacteria closely related to Clostridium cellulosi and Clostridium stercorarium were responsible for cellulose degradation.